An examination of subtype criteria for bulimia nervosa.

OBJECTIVE: We examined the new subtyping criteria for bulimia nervosa by comparing purging and nonpurging bulimia nervosa patients with two similar subgroups: binge eating disorder patients and an eating disorder not otherwise specified (ED-NOS) group who compensates but does not binge eat or meet weight criteria for anorexia, which we labeled compensatory eating disorder (CED). Of particular interest was whether purging could differentiate a more "disturbed" group of patients, bulimic or otherwise. METHOD: We compared these four subgroups on the Eating Disorders Inventory (EDI), the Hopkins Symptom Checklist (SCL-90R), and rates of hospitalization. RESULTS: There were few differences between either the purging or nonpurging bulimic patients, or the CED patients. All three groups showed more comorbid disturbance than the binge eating patients. DISCUSSION: The findings failed to support the current subgrouping criteria for purging and nonpurging bulimia nervosa but indicated the need for further revision in the Diagnostic and statistical manual of mental disorders and the possible creation of a subgroup based on compensatory behaviors.

Coping, sexual abuse, and compensatory behavior.

OBJECTIVE: We explored rates of sexual abuse in different diagnostic subgroups of eating disorder patients, and the extent to which sexually abused patients presented with a higher incidence of disturbed behavior, affective distress, and personality disturbance. Further, we explored Waller's hypothesis that self-criticism may be an important mediator between sexual abuse, compensatory behavior, and personality disturbance. METHOD: We assessed sexual abuse in 103 eating disorder patients, and compared abused and nonabused patients on measures of coping, eating disorder symptoms, affective distress, personality disorders, and behavioral dysregulation. RESULTS: Although the overall rate of abuse was equivalent to previous reports, about 40%, frequency of abuse was strikingly different across diagnostic subgroups, ranging from 12% to 75%. Abuse was lowest in compulsive overeaters (12%) and highest in patients who engaged in compensatory behaviors but did not binge or meet criteria for anorexia (75%). Abused patients were not only more disturbed on comorbid psychiatric symptoms, but were more likely to have engaged in self-injurious behavior (80%) and attempted suicide (75%). Consistent with Waller's model, self-criticism was the only primary coping strategy to differentiate abused from nonabused patients. DISCUSSION: The findings indicate the possible need for a reprioritization of purging and compensatory behaviors in the diagnostic schedule for eating disorders, and the importance of assessing sexual abuse as a comorbid factor.

A breastfeeding evaluation and education tool.

New parents needs a way to assess the adequacy of their baby's breastfeeding. Health care providers, in addition, need a tool for teaching breastfeeding technique. This article describes a tool that focuses parental attention on eight elements relating to early breastfeeding: feedings, positioning, latch, suck, milk flow, intake, output, and infant weight gain.

Coping and depression in bulimia nervosa.

OBJECTIVE: While theoretical models of bulimia have tended to emphasize single dimensions of the disorder, such as cognition or depression, factor analytic studies suggest that bulimia is best represented by a multifactorial model. In this study, we explore whether bulimia nervosa patients with different levels of depression display different types of coping. METHOD: Bulimia nervosa clinic patients were divided into four subgroups based on level of depression and asked to respond to the Coping Strategies Inventory. RESULTS: The results suggest that avoidant or disengaged coping may be more related to affective symptoms than to bulimia, itself. While problem solving and cognitive restructuring did not appear to differ between the subgroups in this study, there were significant differences in social support seeking among the four groups. DISCUSSION: The findings suggest that bulimic patients who present with the affective and personality disordered dimension of bulimia need interventions that focus on the utilization of social support.

Early trauma, dissociation, and late onset in the eating disorders.

Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self-destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms.

Multifactorial assessment of bulimia nervosa.

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.

The Revised Asthma Problem Behavior Checklist.

The Asthma Problem Behavior Checklist (APBC) has proved to be an accurate and invaluable instrument for pinpointing potential behavioral problems in children with the disorder. This article presents the Revised Asthma Problem Behavior Checklist (RAPBC). The value of the RAPBC is that: (a) it has proven reliability when tested with asthmatic adults; (b) the change from a dichotomous yes/no format, used in the APBC, to a 5-point Likert-type answer format adds greater sensitivity to the instrument; and (c) data gathered with the RAPBC compare favorably to information gathered in two previous studies with the APBC. Considering the reliability and validity of the RAPBC, it should prove useful in both clinical and research settings.

The "Asthma Self-Efficacy Scale".

According to Bandura, a person's expectations that a favorable outcome will follow a particular behavior are not sufficient to promote the occurrence of the behavior; the person must also believe that he or she will be effective at performing the behavior. The latter is referred to as self-efficacy. It has become a major focus in assessing patient performance of skills required to manage their illness. The present paper describes the development, testing, and applicability of an instrument for assessing self-efficacy in asthmatic patients. It notes that the Asthma Self-Efficacy Scale is not only a reliable paper-and-pencil instrument, but that it has a wide potential applicability throughout health care settings in measuring self-efficacy in asthmatic patients. The Asthma Self-Efficacy Scale is included.

A method for studying controlled substance use: a preliminary investigation.

This study examined relapse following treatment in a smoking reduction program. Twenty-two smokers with an average daily smoking rate of 25.7 cigarettes were provided a reduction-oriented smoking self-management program. Subjects were then classified on the basis of their reduction at posttreatment. A 50% or greater reduction from pretreatment qualified subjects as successful reducers. To provide further understanding of controlled smoking, subjects who successfully maintained at least a 50% reduction (at three month follow-up) were compared to those subjects who were unable to maintain that level of reduced smoking. A set of cognitive, smoking history, and reduction motivation variables were used to compare the two groups in a stepwise discriminant function analysis. Two variables, internal locus of control and self-label as a nonsmoker, produced an overall correct classification rate of 88.9%. Multiple regression analyses further demonstrated the importance of these two cognitive variables; self-label and internal locus of control accounted for 50.4% of the variance in smoking at three months follow-up. The implications of these findings for future study of controlled smoking are discussed.